Aug. 28, 2009 -- Acute intoxication with the anestheticpropofol, coupled
with the effect of the sedative drug
Ativan, killed pop star Michael Jackson on June 25, the Los Angeles
County Coroner's Office announced today.

The manner of death has been ruled a homicide, according to the news release
issued Friday morning by the department of coroner.

In part, the statement reads: "The drugs propofol and lorazepam [Ativan, a
benzodiazepine sedative] were found to be the primary drugs responsible for Mr.
Jackson's death. Other drugs detected were: Midazolam [Versed], Diazepam [Valium], Lidocaine, and Ephedrine."

Although the toxicology report is complete, the final coroner's report "will
remain on Security Hold at the request of the Los Angeles Police Department and
the Los Angeles County District Attorney," the news release says. No further
comment from department officials was offered beyond the news release.

Earlier this week, news reports surfaced that "lethal levels" of propofol
caused Jackson's death, quoting information from a search warrant affidavit
unsealed in Houston. But anesthesiologists contacted by WebMD cast doubt on the
idea that the amount of propofol quoted in news reports -- 25 milligrams and 50
milligrams -- could be enough to kill a person even of Jackson's slender frame.
They speculated that other drugs must have played a role, and the coroner's
report verifies that idea.

"Maybe that small amount of propofol was enough to harm him when taken with
other drugs," says John Dombrowsi, MD, a Washington, D.C., anesthesiologist and
member of the board of directors of the American Society of Anesthesiologists,
who reviewed the statement today for WebMD.

Although the official statement does not say how the drugs contributed to
Jackson's death, Dombrowski and other experts say that the propofol, with its
sedating properties, plus the sedative properties of the multiple other drugs
detected, could result in respiratory arrest.

The lidocaine mentioned in the coroner's statement, he says, was probably
mixed with the propofol, which Dombrowski says is a common practice among
anesthesiologists. "Propofol in and of itself can irritate the vein," he says.
"When you mix propofol and lidocaine, a small amount, it prevents the burning
aspect."

Versed is a short-acting benzodiazepine used as a general anesthetic, such
as during a colonoscopy. And the ephedrine mentioned in the coroner's
statement? "Ephedrine may have been one of the rescue medications given,"
Dombrowski speculates, once the combination of drugs appeared to be getting
Jackson into trouble.